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Disorders of consciousness
Tornóci László
Semmelweis University
Institute of Pathophysiology
Consciousness is special
This is the only topic in our subject which doesn’t apply to animals.
Other things thought to be unique to humans:
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speech (language)
foresight
tool making
free will
helping others
empathy
sense of morality
(distribution of work,
living in a ‘society’ is
observed in animal
species)
There is increasing evidence that these are biologically based,
so not as much unique to humans, as we may like to believe.
Elements of consciousness in
animals
•Separation of body and environment
•Ability to communicate (sign language)
•Ability to count
•Ability to decieve others, „to lie”
Wild minds
What animals really think?
Self consciousness
• subjective feeling (somewhere in the head)
• no specific center has been found
corresponding to this sensation (this would be
the home of our soul, according to some)
• sSome expert say self consciousness is an
illusion (Daniel C. Dennett, Susan Blackmore)
We can get information about the self consciousness of
another person only indirectly, mostly by attempting to
communicate with him/her.
Suggested book about memes,
evolution and nature of consciousness
Consciousness has two
components
• level (quantity, arousal or vigility)
the brain is active (‘turned on’)
• content (quality)
the brain functions (clear thinking)
Disorders of consciousness
• quantitative (impaired arousal)
• qualitative (impaired content)
Impaired arousal causes disorder of content,
but impaired content is possible with normal
arousal.
Quantitative disorders of
consciousness
• obtundation (impaired perception, slow reactions)
• somnolence (the patient falls asleep, but can be
waken up)
• stupor (the patient can be waken up by strong
stimuli, for a few seconds only)
• coma (the patient cannot be waken up by any
means)
brain death (flat EEG, cardiorespiratory
support needed)
Coma like syndromes
• vegetative state (seemingly awake patient,
normal wake-sleep cycles, no cardiorespiratory support needed, but no cortical
function)
• locked-in syndrome (selective deefferentation, pseudocoma: patient may move the
eyes)
• catatonia (psychiatric disorder)
Qualitative disorders of
consciousness
• confusion (lack of clarity in thinking,
illusions, hallucinations may occur)
• delirium (agitated, hypersympathotonic state
with hallucinations)
Often due to alcohol/drug withdrawal.
• other psychiatric disorders
Sleeping
Sleeping, is dangerous because we are unconscious!
Why do we sleep?
• Sleeping provides rest, regeneration
• Sleeping saves energy, when we cannot do
anything useful (hibernation)
• Only the brain needs sleeping, during which it is
in a special state
Sleeping disorders
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Insomnia
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Hypersomnia
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stress, bad habit, drug effect, depression, mania, restless legs
syndrome etc.
narcolepsy (sleepy during the day, bad sleep during the night,
cataplexy, persistent sleep paralysis, hypnagogue hallucinations)
depression (light deprivation)
Parasomnias
Parasomnias
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somnambulism
bruxism (grinding of the teeth)
pavor nocturnus (night terrors)
enuresis nocturna
Current interpretation of sleep
paralysis: abduction by aliens
• Wake up to be paralyzed, unable to defend
oneself
• Feeling the presence of others in the room
• Sliding with the bed, buzzing sound, lights
above (operation)
• Sexual intercourse
Interpretation of sleep paralysis/night
terrors in the middle age
Succubus: sexually desirable witch
Interpretation of sleep paralysis/night
terrors in the middle age
Incubus: creature sitting on the chest
Henry Fuseli (1741-1825)